Alcohol Intoxication
DSM-II In DSM-II, this disorder is called Acute alcohol intoxication All varieties of acute brain syndromes of psychotic proportion caused by alcohol are included here if they do not manifest features of delirium tremens, alcoholic hallucinosis, or pathological intoxication. This diagnosis is used alone when there is no other psychiatric disorder or as an additional diagnosis with other psychiatric conditions including alcoholism. The condition should not be confused with simple drunkenness, which does not involve psychosis. DSM-III For more information, see Intoxication Diagnostic Criteria A'''. Recent ingestion of alcohol (with no evidence suggesting that the amount was insufficient to cause intoxication in most people). '''B. Maladaptive behavioral effects, e.g., fighting, impaired judgment, interference with social or occupational functioning. C'''. At least one of the following physiological signs: # slurred speech # incoordination # unsteady gait # nystagmus # flushed face '''D. At least one of the following psychological signs: # mood change # irritability # loquacity # impaired attention E'''. Not due to any other physical or mental disorder. '''Differential Diagnosis Social drinking Social drinking is associated with physiological intoxication. Maladaptive behavior is required for the mental disorder Alcohol Intoxication to be diagnosed. Barbiturate or Similarly Acting Sedatives or Hypnotic Intoxication Intoxication due to barbiturates and similarly acting sedatives and hypnotics has the same clinical picture as Alcohol Intoxication. Since an individual may be taking both alcohol and other substances, the presence of alcohol on the breath does not exclude the possibility that another substance is responsible for the intoxication. Neurological diseases Certain neurological diseases, such as cerebellar ataxias or multiple sclerosis, may have some of the physiological signs and symptoms of Alcohol Intoxication. Alcohol Idiosyncratic Intoxication In Alcohol Idiosyncratic Intoxication, a marked change in behavior follows ingestion of an amount of alcohol that is insufficient to cause Alcohol Intoxication in most individuals. DSM-IV For more information, see'' Substance Intoxication'' The essential feature of Alcohol Intoxication is the presence of clinically significant maladaptive behavioral of psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgement, impaired social or occupational functioning) that develop during, or shortly after, the ingestion of alcohol (Criteria A and B). These changes are accompanied by evidence of slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, or stupor or coma (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D). The resulting picture is similar to what is observed during Benzodiazepine or Barbiturate Intoxication. The levels of incoordination can interfere with driving abilities and with performing usual activities to the point of causing accidents. Evidence of alcohol use can be obtained by smelling alcohol on the individual's breath, eliciting a history from the individual or another observer, and, when needed, having the individual undertake breath, blood, or urine toxicology analyses. Diagnostic Criteria A'''. Recent ingestion of alcohol. '''B. Clinically significant maladaptive behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgement, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion. C'''. One (or more) of the following signs, developing during, or shortly after, alcohol use: # slurred speech # incoordination # unsteady gait # nystagmus # impairment in attention or memory # stupor or coma '''D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. DSM-5 Diagnostic Criteria A'''. Recent ingestion of alcohol. '''B. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgement) that developed during, or shortly after, alcohol ingestion. C'''. One (or more) of the following signs or symptoms developing during, or shortly after, alcohol use: # Slurred speech. # Incoordination. # Unsteady guilt. # Nystagmus. # Impairment in attention or memory. # Stupor or coma. '''D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Differential Diagnosis Other medical conditions Several medical (e.g., diabetic acidosis) and neurological conditions (e.g., cerebellar ataxia, multiple sclerosis) can temporarily resemble alcohol intoxication. Sedative, hypnotic, or anxiolytic intoxication Intoxication with sedative, hypnotic, or anxiolytic drugs or with other sedating substances (e.g., antihistamines, anticholinergic drugs) can be mistaken for alcohol intoxication. The differential requires observing alcohol on the breath, measuring blood or breath alcohol levels, ordering a medical workup, and gathering a good history. The signs and symptoms of sedative-hypnotic intoxication are very similar to those observed with alcohol and include similar problematic behavioral or psychological changes. These changes are accompanied by evidence of impaired functioning and judgement - which, if intense, can result in a life-threatening coma - and levels of incoordination that can interfere with driving abilities and with performing usual activities. However, there is no smell as there is with alcohol, but there is likely to be evidence of misuse of the depressant drug in the blood or urine toxicology analyses.